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. 2025 Mar 20:12:1560913.
doi: 10.3389/fnut.2025.1560913. eCollection 2025.

Effects of dietary oxidative balance score on diabetic nephropathy and renal function: insights from retrospective and cross-sectional studies

Yong Huang #  1 , Linfeng Wang #  1 , Gaojie Zhang #  1 , Yueqiang Peng  2 , Qiao Xu  3 , Ziling Wei  4 , Jiang Yu  1 , Huayang Zhang  5 , Yao Zhang  1 , Jiayu Liu  1
Affiliations

Effects of dietary oxidative balance score on diabetic nephropathy and renal function: insights from retrospective and cross-sectional studies

Yong Huang et al. Front Nutr. .

Abstract

Background: The relationship between dietary oxidative balance score (DOBS) and diabetes-related renal events remains unclear.

Methods: In this study, the associations between serum micronutrients and diabetic nephropathy (DN) in participants matched by propensity score (PSM) were retrospectively analyzed. And next, a cross-sectional analysis was performed with the National Health and Nutritional Examination Survey (NHANES) database. Weighted multivariate adjusted logistic regression models, dose-response curves, subgroup analysis, and mediation analysis were the main methods of this study. Finally, sensitivity analyses were performed by PSM and multiple imputation (MI).

Results: Retrospective findings suggest that single antioxidants may not be representative of an individual's overall antioxidant levels. The results of the cross-sectional study indicated that the higher the DOBS, the greater the beneficial effects on DN [Q4 vs. Q1: OR (95% CI): 0.78 (0.63, 0.96), p for trend = 0.008] and renal function in DN [Q4 vs. Q1: β (95% CI): 5.395 (1.590, 9.199), p for trend = 0.004]. The above correlations were linear negative correlation (p for nonlinear = 0.989) and linear positive correlation (p for nonlinear = 0.593) respectively. Chronic inflammation mediated the above associations to some extent. The results of sensitivity analysis were consistent with the original analysis.

Conclusion: Higher dietary antioxidant exposure has a positive effect on DN and renal function in DN, mediated partially by chronic inflammation.

Keywords: NHANES; chronic inflammation; diabetic nephropathy; dietary oxidative balance score; renal function.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
The general flowchart of this study. DOBS, Dietary oxidative balance score; DN, Diabetic nephropathy; UACR, Urine albumin-to-creatinine ratio; eGFR, estimated glomerular filtration rate; WBC, White blood cell; CRP, C-reactive protein; INFLA-score, Low-grade inflammation score; BMI, Body mass index.
Figure 2
Figure 2
Dose–response relationship between DOBS and DN and eGFR in DN before and after PSM through RCS. (A) RCS of DOBS and DN before PSM; (B) RCS of DOBS and eGFR in DN before PSM; (C) RCS of DOBS and DN after PSM; (D) RCS of DOBS and eGFR in DN after PSM. DOBS, Dietary oxidative balance score; DN, Diabetic nephropathy; eGFR, estimated glomerular filtration rate; RCS, Restricted cubic splines; PSM, Propensity score matching; OR, Odds ratio.
Figure 3
Figure 3
The relationship between DOBS and inflammation-mediating factors. DOBS, Dietary oxidative balance score; WBC, White blood cell; L, Lymphocyte; M, Monocyte; N, Neutrophil; CRP, C-reactive protein; INFLA-score, Low-grade inflammation score.
Figure 4
Figure 4
Mediation analyses with inflammatory factors between the association of DOBS and DN and eGFR in DN. DOBS, Dietary oxidative balance score; DN, Diabetic nephropathy; CRP, C-reactive protein; INFLA-score, Low-grade inflammation score; IE, Indirect effect; DE, Direct effect.
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